not long ago it was a lifesaving medical milestone now Erin Moriarty with a CBS News investigation into dialysis a revolutionary treatment that's become a big business a very big business a suspect is in custody on an attempted murder charge a tranquil suburb of Terre Haute Indiana was shaken by reports this past January a male was shot in the hand that one doctor who treats kidney patients but he shot me with a handgun had been shot and wounded by another outside his home almost as jarring as the crime was the apparent motive of the alleged assailant Dr Andre Obua Obua allegedly told a nurse that there was a multi-million dollar scam involving several doctors and said this was not just a conflict between two doctors our reporting has found evidence that the shooter may have been inspired by the murder of the UnitedHealthcare CEO last December in letters sent to CBS News from Jail Dr Obua writes that he's trying to expose the harm he sees to patients in an area of medicine that gets little attention the big business of dialysis LQ is it fair to say you're living literally day to day yes literally literally this is how 35 year-old LaQuayia Goldring she goes by LQ spends up to 4 and 1/2 hours of most days there's that hooked up to a dialysis machine yeah that's good that does what her kidneys no longer can it takes the blood from her body removes waste and excess fluids and cycles it back in without this treatment in her home near Louisville Kentucky she would die every day I wake up I am thanking God that my feet even hit the ground and that my eyes open and I could still breathe on my own these are me as a toddler before I was sick goldring was just three when cancer destroyed one kidney and badly damaged the other this was the day that I got my transplant that a kidney transplant she received as a teenager gave her back her life but after it failed in 2014 she had to go back on dialysis she's been waiting more than 10 years for another kidney every day it's war and it's a harder fight every day and the more years I'm on it the harder it is the life expectancy for patients on dialysis is only 5 years patients are often older with other serious health issues goldring has been able to survive in part because she gets her dialysis treatment at home when she needs it and for as long as she needs it the great majority of patients instead get dialysis in outpatient clinics almost always run by for-profit corporations and where critics say the treatment is designed to maximize company profits over patients needs this is fast food dialysis if you will one size fits all in and out as quick as possible and how's our stock price doing tom Mueller is the author of How to Make a Killing an investigation of the dialysis industry currently dominated by for profit corporations resulting he says in not just higher costs but also among the highest mortality rates in America patients on dialysis die one to two times faster than in any other developed country and why is that people are not given the tailored treatment that they need and above all they're given too brief dialysis and too high ultra filtration rates so two aggressive dialysis and it's done in order to pack more patients into dialysis clinics companies profiting from a life-saving treatment is not what Congress had in mind says Mueller when it decided in 1972 that taxpayers would pay for dialysis through Medicare mr duff suffers from what is known as chronic kidney failure in the 1960s when dialysis was first made possible there were so few machines and the cost was so high these are volunteers anonymous volunteers that a hospital in Seattle formed a panel of peers to decide who should get dialysis this was the group who decided who would live and who would die mr duff what happened to those who had turned down they're dead the panel was called the God Committee was that really one of the incentives for Congress to say "We've we've got to make this fair for people." Absolutely when it's life or death a number of people were saying "We're giving billions to the arms race and we can't save our own citizens." Back then there were fewer than 10,000 people who needed dialysis but today the number of patients has skyrocketed to more than half a million Americans while some have private insurance most still rely on the federal government to foot the bill and that bill is enormous we're spending over $40 billion a year through Medicare in fact it's actually 1% of the entire federal budget which is a staggering statistic Ryan McDevitt a professor of economics at Duke is co-author of a recently released study which suggests the high cost of dialysis can be blamed on the lack of competition at this point we have two firms Davita and Fresenius they have almost 80% of facilities across the country this is the most concentrated healthcare sector across the entire US we've never seen anything like this we have a corporate model that provides the least amount of care for the most amount of profit for shareholders dr leonard Stern a nephrologist at Columbia University in New York says he speaks from experience he served as medical director at what he says was one of the nation's premier centers which was then sold to Davita in 2005 you were the clinic's director there was a I didn't have a choice of who I hired Davita took over that responsibility if I wanted the patient to get 5 hours of treatment that day I typically wasn't able to order it what do you mean they refused dr stern left the clinic in 2013 serious concerns about the dialysis industry as a whole continue to this day a CBS News investigation found that one third of all dialysis clinics nationwide failed to meet federal performance standards this year alone let me tell you about a moment I was in there that was enough for me LQ Goldring also spent years getting dialysis at a clinic run by another for-profit company my arm at the time was bleeding a lot and this point had been almost two hours and I'd asked for them to call the EMTs and they didn't instead they rode my chair to the side and said "Miss Goldring we're putting another patient in your seat uh we'll be back with you." Since 2013 centers have been cited for more than 115,000 deficiencies around 67% of those deficiencies were split between clinics reported to be owned by Davita or Fresenius you would sometimes find blood stains still on the armrest blood stains in front of you on the floor that no one's been able to clean up because they're too busy 53year-old Jeff Parke who lives in Ellington Florida has been on and off dialysis for nearly three decades he now gets dialysis 4 days a week using Fresenius equipment at home but for years he went to Davita and Fresenius clinics where the dialysis flow rate he thinks was too fast your blood pressure is dropping dramatically or sometimes it's going up through the roof how often will that happen to you in center all the time and if you find yourself in a crisis as a patient there's no call button you're yelling you're screaming it's happened to me many times both Davita and Fresenius declined on camera interviews in a statement Fresenius says "Providing high quality care is our standard." And Davita states they consistently deliver high quality individualized care and to mischaracterize anomalies as systemic care failures is reckless fear-mongering and puts patient well-being at risk since 2015 Fresenius and Davita paid out at least 1.13 billion dollars in settling 25 civil lawsuits i have not seen any improvement in care following these settlements this is like paying the rent or paying your employees it's better to break some rules and pay a fine than to give up these billions of dollars in profits last year the two companies combined brought in $33 billion from all their businesses which brings us back to that disturbing case in Indiana where a kidney specialist was shot hey pat him down with me the accused Assailant Dr Andre Obua says he was convinced that some doctors were prescribing an off label medication that could put dialysis patients at risk in his letters Obua also hinted that he had been inspired by Luigi Mangione the alleged assassin of the United Healthcare CEO and like him Obua wrote "There was monopoly money in the car when I was arrested." Dr Obua is scheduled to go on trial for attempted murder this August the county prosecutor told us that resorting to violence is never the way to bring attention to an issue but those who study dialysis do think something needs to change go back to the system we had 20 30 years ago fragmented competition working competing for patients giving them a choice potentially advocating for more home dialysis but even home dialysis takes a terrible toll my face and my chest swell my heart hurts all the time right in this area LQ Goldring is now on three waitlists for a kidney transplant the only way off dialysis the odds are against her there is 100 about 103,000 people waiting for kidneys right now i'm just one trying to be a voice for all of us just hoping that more of us will be transplanted all right get her to help you on that side until a kidney is found she's doing everything she can to speed up the process i've basically became my own marketing team gives me hope but her time is running out every day I feel like I am standing with one foot in the grave and one foot on this side waiting by the phone hoping that it rings